Vesticon is developing a Nystagmus-Based Repositioning (NBR) System (known in Phase I as Headmounted Positional Management System) for diagnosis and treatment of positional manifestations of vertigo for application at medical facilities. The NBR System will provide advanced, rapid analysis of nystagmus and graphic and textual guidance for carrying out repositioning maneuvers (RMs) manually on an exam table. Dizziness and balance disorders are common problems, with 6.2 million Americans chronically affected between ages 40 and 69, and a majority of those over age 70 reporting balance problems, where balance related falls account for more than half of accidental deaths in the elderly. The most common vestibular disorder is positional vertigo, or BPPV. Current diagnostic and treatment protocols limit optimal care and prevention of untoward consequences. Additionally, existing technology was developed before BPPV was well understood and, therefore, has limited diagnostic utility and is not designed for treatment. The NBR System will monitor spatial orientation and head/ torso motion, coupled with videographic eye movements and novel 3-D nystagmus analysis, to display data in intuitive 3-D animation, and provide guidelines for diagnostic and treatment maneuvers. Phase I goals were met or exceeded: we integrated 3-D VNG software with inertia sensors via software and hardware components and developed basic maneuver protocols and first-level guidance with interactive 3-D animation of real-time conditions. We then demonstrated clinical value of the prototype in a human feasibility study with a small subject cohort. For Phase II, we will: a) develop advanced diagnosis and treatment protocols from 1000+ database, outside expert review and beta site feedback; b) develop additional software and hardware to implement and integrate protocols, including VNG algorithm refinement, optimization and a PC hardware solution with advantages over existing vestibular technology; c) develop four beta units with wireless transmission; d) demonstrate improved clinical applications in a human study with a large subject population.